Meningitis victims face big medical bills, legal disputes

Oct. 14, 2012

John Horrell of Nashville, Tenn., is waiting to find out if a potentially tainted steroid injection he got for back pain will result in him getting fungal meningitis. His wife, Martha, got a less dangerous form of the disease, viral meningitis, in 2001. / Tennessean photo/John Partipilo

Written by

Heidi Hall

The Tennessean

He’d received a steroid epidural for back pain at St. Thomas Outpatient Neurosurgery Center in Nashville. A doctor administered his single dose in the potentially deadly time frame. He’d seen the news reports.

So Horrell wasn’t surprised when on Oct. 5, four days after the Tennessee health department’s announcement about the outbreak, he opened a letter from St. Thomas saying he might be at risk.

The next envelope he opened: A $422.88 bill for the injection that might kill him.

“I would like to not have to pay it. I hate to think I would have to sue somebody to keep from having to pay it,” Horrell said. “But I anticipate it would be easier to pay it than go through the bureaucracy.”

He’s healthy so far, but 220 other cases across 14 states haven’t gone as well. Some are battling the disease in hospitals, and 15 have died. The numbers are expected to grow, as health officials estimate 14,000 people may have been exposed to fungus-tainted steroids.

No state has been more affected than Tennessee, where six patients have died and 53 others are ill, according to the federal government.

Those affected face a complicated medical and legal road ahead. Analysts won’t even estimate the potential costs or the broad impact the outbreak will have on individual patients, insurance companies or hospitals. But medical bills alone will be in the millions of dollars. Survivors of more common forms of meningitis report being in the hospital from a week to a month.

The neurosurgery center here hasn’t answered whether it will pay for care that develops from tainted epidurals given in its pain clinic. If people affected by the epidurals seek follow-up care at St. Thomas Hospital, which housed the center, they will be billed like typical patients, according to hospital spokeswoman Rebecca Climer.

For now, some patients and their attorneys say private insurance is covering expenses as with any other medical issue.

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Medicare will cover expenses from the outbreak for its clients, said Centers for Medicare & Medicaid Services spokesman Brian Cook.

Frightened steroid injection patients have been calling the Arizona-based Meningitis Foundation of America, which helps people who develop the disease find assistance.

“Everybody and each outcome is different, depending on the body that has the disease,” said Caroline Petrie, the group’s national secretary. “Many survivors have described a migraine from hell. They don’t want to be in the light, don’t want to talk to people. Some people suffer to the point where they’re on Social Security. It’s so devastating that they’re not going to be able to work.”

Legal issues emerge

After people call their doctors, they might want to call their lawyers, because the courts will decide whether patients are compensated for what happens to them, said John Day, a lawyer who wrote three books on personal injury lawsuits.

On Thursday, a woman who received an injection but hasn’t developed meningitis filed suit in U.S. District Court in Minnesota against Framingham, Mass.-based New England Compounding Center, which federal investigators identified as the likely source of contaminated injections. Her suit seeks class-action status for other victims in Minnesota.

Lawyers must sort out who to sue and for what, and that won’t be easy, Day said. There will be three classes of potential plaintiffs: people who were exposed to the fungus but never developed meningitis, those who developed meningitis and survived with various levels of effects, and the survivors of those who died from the disease.

The most obvious choice for all to sue is the drug manufacturer, Day said.

“If they are combining drugs at New England Compounding Center … they are responsible to make sure those are not dangerous,” Day said. “The doctor who gives the injection would not be liable for what happened unless he or she knew something was wrong with the product.”

If a judge declares New England Compounding Center insolvent, then victims can try suing the hospital or related parties, Day said.

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How far the compounding center’s insurance will go won’t likely be known until litigation reveals it, but the Boston Globe reported the company earned $8 million in 2009, the latest records available.

If New England Compounding Center’s resources are exhausted and victims turn to St. Thomas, the hospital should be able to cover their costs, said Joshua Nemzoff, a New Hope, Pa., hospital consultant formerly based in Nashville. St. Thomas is affiliated with Ascension Health, the nation’s largest nonprofit hospital network.

“The treatment will be covered by insurance, but liability is another story,” Nemzoff said. “It’s nice for everyone to talk about suing St. Thomas, but plenty of people sue for all kinds of reasons, and they have to prove someone was negligent. That’s a much higher bar to get over.”

Horrell is still awaiting word about whether he will have to pay his $422.88 bill, which he shipped back to St. Thomas with an angry letter. He’s taking life a day at a time, counting himself lucky for each one that passes without signs of meningitis.

For his wife, Martha, the pain is personal. She contracted viral meningitis in 2001 and knows all about the insidious disease, the months of recovery, the migraines that serve as battle scars.

The couple lingered in an embrace Friday at his office, Martha Horrell tearful at the memories of her own struggle and what her husband might face.

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